Transcatheter closure of patent ductus arteriosus using Gianturco coil: Jordanian experience

ABSTRACT

To assess the immediate and mid-term results of transcatheter closure of patent ductus arteriosus [PDA] less than 4 mm in diameter using single or multiple Gianturco coils. Settings Queen Alia Heart Institute, a tertiary center for cardiac patients, Amman, Jordan. Patients And From December 1977 to January 2002, 32 patients [21 female, 11 male] underwent a transcatheter closure of a small PDA less than 4 mm in diameter in our institution as an alternative to standard surgical ligation. The patient's mean age was 8.4 years [range 1-27 years]; their mean weight was 26.5 kg [range 8-81 kg]. All patients were asymptomatic. Gianturco stainless steel coils [Cook] with thrombogenic strands attached to them were used for closure. The mean followup period was 2.1 years [range 0.5-4]. The mean narrowest PDAdiameter was 2.8 mm range [1.4-4], the mean pulmonary/systemic flow ratio was 1.57 range [1.22-2.5]. A single coil was used in 24 patients [75%], four patients [12.5%] needed two coils, four patients [12.5%] needed three coils to achieve complete closure of the PDA. The patients who had two or three coils, had larger shunts with PDA's narrowest diameter more than 3.5 mm. There were two incidents of coil migration to the left pulmonary artery, which were retrieved with a gooseneck snare. There was immediate and complete closure in 28 patients out of 32 [87.5%] as confirmed by post-closure descending aortogram. Four patients had residual shunt, which disappeared after 24 hours. All patients were discharged home one day after the procedure. Coil occlusion of PDA less than 4 mm was safe and effective. Immediate success rate was high. Residual shunts were commonly observed immediately following coil occlusion, but spontaneous closure occurs in all patients. The risk of coil embolization was less in PDA less than 4 mm in diameter. No complications have been encountered during the first four years of follow up